_______________________________________________________________________________
Title:      Health and Human Services Issues
Subtitle:

Report No.: GAO/OCG-93-20TR       Date:  December 1992
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Author:     United States General Accounting Office
           Office of the Comptroller General

Addressee:  Transition Series

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_______________________________________________________________________________

CONTENTS

Health and Human Services Issues
Bolstering the Public's Confidence in Social Security and Ensuring
  High-Quality Services
     - Gaining the Public's Confidence
     - Ensuring High-quality Services
Exercising Stronger Leadership to Achieve Welfare Reform
     - Intensifying Efforts to Improve Data and Data Systems
     - Developing Goal-Oriented Program Performance Standards
     - Identifying and Sharing Effective Initiatives
Expanding States' Use of Child Welfare Funds
Allocating FDA's Resources Efficiently and Establishing a Regulation Tracking
  System
Related GAO Products
     - Departmental Issues
     - Health Care Financing
     - Social Security
     - Welfare Reform
     - Child Welfare Services
     - Food and Drug Administration
Transition Series
     - Economics
     - Management
     - Program Areas




















_______________________________________________________________________________

Office of the Comptroller General
Washington, DC 20548

December 1992

The Speaker of the House of Representatives
The Majority Leader of the Senate

In response to your request, this transition series report discusses major
policy, management, and program issues facing the Congress and the new
administration in the areas of health and human services. The issues include
(1) strengthening the social security system, (2) reforming the nation's
welfare system, (3) keeping families intact and protecting children from abuse
and neglect, and (4) adequately safeguarding the nation's food and drug
supply.

Another report in this transition series, _Health Care Reform_
(GAO/OCG-93-8TR, Dec. 1992), discusses shaping an effective approach to
national health care reform. Also, as part of our high-risk series on program
areas vulnerable to fraud, waste, abuse, and mismanagement, we are issuing a
related report, _Medicare Claims_ (GAO/HR-93-6, Dec. 1992).

The GAO products upon which this transition series report is based are listed
at the end of this report.

We are also sending copies of this report to the President-elect, the
Republican leadership of the Congress, the appropriate congressional
committees, and the Secretary-designate of Health and Human Services.

Signed: Charles A. Bowsher



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HEALTH AND HUMAN SERVICES ISSUES
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The Department of Health and Human Services (HHS) oversees hundreds of federal
programs that are vital to the health and welfare of virtually every American.
Its programs help ensure adequate health care; provide income security for the
aged, poor, and disabled; help the disadvantaged become productive citizens;
protect children and other vulnerable populations; and safeguard the nation's
food and drug supply. HHS's fiscal year 1992 budget was about $550 billion, or
nearly 37 percent of the federal government's total budget. About 86 percent
of these funds were for social security, Medicare, and Medicaid.

The new administration and the 103rd Congress will have to deal with several
significant social policy issues. We discussed some of these issues in our
1988 transition series report; others appear for the first time in this
report. Among the more important issues demanding attention are the following.

-- Health care is one of the greatest current domestic challenges. Issues
  include ensuring adequate access to health care; controlling health care
  costs; and curbing Medicare funds lost through fraud, waste, and abuse.
  Because of the importance of these issues, we discuss them in a separate
  transition series report on health care reform and in a high-risk series
  report on Medicare.

-- Second, public confidence in social security programs has eroded and must
  be restored. To bolster the public's confidence, the trust funds need to
  continue growing to a level sufficient to withstand economic downturns. In
  addition, workers need to know what their benefits will be and have
  assurance that those benefits will be there when they need them. Social
  security services must be delivered more efficiently and effectively,
  particularly in view of the unprecedented number of "baby boomers" whose
  retirement will impose a great demand on the system. Service for the
  disabled has already deteriorated to the point that claimants must wait up
  to 4 months for a disability decision, and the situation is worsening.
  Also, the disability program is rapidly running out of money and may need
  major reforms.

-- Third, without closer attention to states' implementation efforts, the
  major welfare reform effort of the late 1980s may fail. Legislation enacted
  then was designed to help dependent families achieve self-sufficiency
  through work. Its implementation, however, has been slowed by skyrocketing
  caseloads and state budget constraints. The new administration and the
  Congress will need to ensure that fledgling programs associated with
  welfare reform are properly implemented. As states' welfare reform efforts
  are evaluated and their outcomes and impacts analyzed, changes based on
  successful experiments should be instituted to reshape the program.

-- Finally, child welfare programs, designed for a different era, need to be
  changed. More children live in poverty--one in five--than ever before,
  reported cases of child abuse and neglect are at record levels, and the
  foster care system is struggling to accommodate increasing caseloads. The
  new administration and the Congress need to focus on prevention and early
  intervention programs to help keep families intact. Also, an active federal
  strategy for collecting data, disseminating information about best
  practices, and evaluating child welfare programs is needed. Local
  governments need this information to support their efforts to provide the
  most appropriate services at the right time and in the right place.

These and other issues will demand strong leadership from the Congress and
HHS. With resources limited, HHS and state and local governments will need to
work smarter and work together to effectively manage and operate health and
human services programs.

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BOLSTERING THE PUBLIC'S CONFIDENCE IN SOCIAL SECURITY AND ENSURING
HIGH-QUALITY SERVICES
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Sooner or later in their lives, nearly all citizens will be touched by the
social security system. For most aged and disabled Americans, social security
is a key source of income support. In 1991, about $263 billion in social
security benefits was paid to more than 40 million beneficiaries. In recent
years, however, the public's confidence in the social security system has
eroded. Many are concerned that monies will not be there to pay their benefits
in the future.

To help build the public's confidence in the social security system, the
Social Security Administration (SSA) should take steps to ensure an adequate
contingency reserve and provide workers with a tangible sense of what their
benefits will be. In addition, to ensure high-quality services, SSA must
modernize its computer systems and strategically manage its resources. SSA's
computer modernization could cost billions of dollars over the next 10 years.
SSA also needs to expand its research information about the disability and
supplemental security income programs in order to strengthen program
evaluation and management and enable it to consider alternative program
designs.

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GAINING THE PUBLIC'S CONFIDENCE

After SSA's well-publicized financial difficulties in the early 1980s, many
people believe that social security funds will not be sufficient to pay their
benefits when they retire. In recent years, actions have been taken to build
the public's confidence in the social security system. These actions include
changing the methods of financing the trust fund, requiring that annual
statements of personal earnings and benefits be provided to individuals, and
making financial management improvements, such as preparing annual audited
financial statements of SSA.

To further build public confidence, the social security trust fund needs to
grow to a level sufficient to withstand economic downturns. Current financing
plans for the social security trust fund, which envision accumulating a $5.5
trillion reserve by 2025, set contribution rates higher than necessary to pay
current benefits. This plan has been controversial. Some believe that if the
reserves add to national savings or are used for government activities that
enhance future economic growth, the burden of financing future retirement
costs can be reduced. Others, however, doubt that the reserves will be used
for these purposes and believe that the system should be financed on a
pay-as-you-go basis, in which annual revenues closely match annual benefit
payments and the trust funds provide protection against economic downturns. [
Footnote 1:  Our transition series report _Budget Issues_ (GAO/OCG-93-1TR,
Dec. 1992) discusses the relationship between the social security trust fund
surplus and the federal deficit.  ]  If a decision is made to return to a
pay-as-you-go system, we believe that the trust funds should be maintained at
a level adequate to pay benefits for 1 to 1-1/2 years. This level would be
sufficient to offset the reduction in tax revenues that accompanies economic
downturns, thus assuring the public that the system is sound.

In 1990, the Congress mandated that SSA provide an annual statement of
personal earnings and benefits to individuals on request. Beginning in 1995,
SSA will have to provide statements to all individuals aged 60 and over and,
by October 1999, annually to all workers covered under social security. This
latter requirement will add very substantially to SSA's work load. It is
important that SSA meet this challenge in order to enhance the public's
confidence in the social security system. These statements will provide
workers with a tangible sense of the benefits they will receive in the future.
Given other anticipated work load increases discussed below, SSA needs to
develop and implement a workable strategy for sending these statements to all
workers.

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ENSURING HIGH-QUALITY SERVICES

Another factor that will dramatically increase SSA's work load is the
impending baby-boom generation retirement. SSA is also experiencing
significant increases in disability cases, and major delays in processing
already exist. At the same time, given the budgetary constraints faced by all
federal agencies, funding for program administration will be limited, placing
greater pressure on SSA's management to provide high-quality public service at
minimum cost. To meet this challenge, SSA must (1) gain a greater
understanding of the public's expectations, (2) logically sequence its
implementation of critical agency plans, (3) reengineer its work processes to
enhance service delivery, (4) identify and train the staff it needs to provide
high-quality services, and (5) enhance its research information to better
understand current trends and consider alternative program designs.

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Understanding the Public's Expectations

Since 1989, SSA has made progress in using strategic management to set
agencywide goals, establish priorities, guide budget decisions, and measure
performance. However, in developing its service objectives and priorities, SSA
ignored a fundamental tenet of effective planning: that meeting the public's
expectations--not internal needs--is the measure of service quality. SSA
proceeded without involving the public, interest groups, or congressional
committees, leaving the agency without assurance that its objectives and
priorities corresponded with the public's expectations. As a result, SSA may
spend its scarce resources on service objectives that it thinks are important
but the public does not.

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Sequencing Implementation of Agency Plans

SSA's strategic management also does not provide a framework for the
completion or correct sequencing of critical agencywide plans--such as plans
for operations service delivery, human resources, facilities, and information
systems. Correct sequencing is necessary to ensure that plans for new computer
systems and facilities, for example, are based on an operations service
delivery plan that sets forth how SSA will conduct business in the future.

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Reengineering Work Processes

To economically and efficiently meet its future service demands, SSA will need
to modernize its information systems. If these systems are not enhanced, SSA
believes it will need about 17,000 additional staff. SSA has taken a number of
steps essential to developing automated information systems. However, much
remains to be done to fully justify SSA's systems modernization plans, which
could cost from $5 billion to $10 billion over the next 10 years.
Specifically, SSA has not completed its operations service delivery plan on
how it will conduct work in the future, including the identification of
alternative work processes. In addition, SSA has not fully justified the costs
and benefits of proposed systems enhancements. Until it takes these actions,
SSA could be acquiring new technologies to automate old processes, rather than
developing new, cost-effective information systems based on more efficient
work processes.

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Training Staff to Deliver Quality Services

SSA has taken a number of steps to improve its work force. However, it does
not have a human resource plan identifying the type and number of personnel
needed to accomplish its service objectives given the anticipated work-load
increase and use of automation. SSA needs a well-trained work force and a
positive work environment to effectively prepare for and handle its future
challenges. But, management has not placed priority on training newly promoted
supervisors and managers for leadership positions. Also, SSA may not be
devoting sufficient training funds to certain operational areas. For example,
field office employees say they lack the training needed to apply agency
policy and use computer systems fully. SSA will be challenged to develop these
critically important training programs in an environment of general budget
constraints, including reductions in its training budget. A human resource
plan covering long- and short-term initiatives for training, improvements to
the work environment, and planning for management succession could ensure the
coordination and continuity of initiatives and the achievement of desired
improvements.

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Developing Research Information on Disabilities

Since 1984, caseloads and costs have risen rapidly in SSA's Disability
Insurance and Supplemental Security Income programs. The agency is having
trouble (1) processing disability claims in a timely manner and (2) performing
legally required reviews of the beneficiary rolls to ensure that beneficiaries
continue to be eligible. Furthermore, SSA lacks adequate research information
to understand current trends and consider alternative designs for these
programs. In addition, the Americans with Disabilities Act places a much
greater emphasis on enabling disabled persons to work than SSA's current
programs do. To succeed in meeting the act's challenge, the agency will need a
focused research program to direct its rehabilitation efforts.

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Improving SSA's Operations

In these times of tight budgets, the Congress has been looking for
opportunities to restrain the growth in federal agencies' administrative
costs. Thus, SSA should not expect any increase in funding and should take
steps to operate more efficiently with the resources it has. The actions it
takes should contribute both to improving the quality of its services and
reducing future administrative costs. To move in this direction, SSA needs to

-- implement comprehensive strategic management that involves the public and
  the Congress in establishing the agency's priorities and direction, and
  ensures successful implementation of agencywide initiatives;

-- ensure that its plans for modernizing information systems adequately
  consider their costs and benefits as well as alternative, more efficient
  work processes;

-- develop a human resource plan to guide the hiring and training of the
  personnel needed to accomplish the agency's long-range objectives and
  coordinate current work-force initiatives; and

-- acquire the information necessary to support program evaluation and
  consideration of policy alternatives for its disability and supplemental
  security income programs.

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EXERCISING STRONGER LEADERSHIP TO ACHIEVE WELFARE REFORM
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With the passage of the Family Support Act of 1988 (FSA), the nation adopted a
new approach to taking care of its poor. The act reflects a new political
consensus on the goal of means-tested, family-focused programs. It emphasizes
greater parental responsibility by encouraging work efforts and increased
cooperation with child support enforcement, instead of primarily providing
cash assistance. In fiscal year 1991, the federal and state governments
provided over $20 billion in cash assistance to needy families with children
through the Aid to Families with Dependent Children (AFDC) program.

This welfare reform effort, however, has gotten off to a rocky start. While
progress has been made, it has been uneven as economic conditions have
worsened in many states since FSA's enactment. States have experienced
unprecedented growth in AFDC caseloads, high unemployment rates, and increased
child support caseloads and Medicaid costs amid revenue shortfalls, creating
serious and possibly long-term budget problems.

Implementation of FSA is still in its early stages, and care must be taken to
fully establish the programs, develop information systems, assess performance,
and evaluate results. Without stronger leadership, direction, and oversight
from HHS, current welfare reform efforts may falter or fail. To help states
keep welfare reform on track and increase the number of welfare-dependent
families that become self-sufficient, HHS needs to

-- intensify its efforts to ensure that states develop the automated data
  systems needed to provide high-quality and timely services to welfare
  clients, effectively manage increasing caseloads, and provide the
  information that management needs to measure progress and set effective
  policies;

-- establish program performance standards based on outcome in addition to
  process-oriented measures to achieve desired program results; and

-- work with states to identify practices that help families achieve
  self-sufficiency and disseminate information about them.

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INTENSIFYING EFFORTS TO IMPROVE DATA AND DATA SYSTEMS

Several federal programs essential to helping children and families achieve
economic self-sufficiency lack national data and automated data systems. Data
collected on a nationwide basis are needed to evaluate these programs and
provide a basis for making policy changes. However, inaccurate and incomplete
data are being collected in several programs, including the child support
enforcement, Job Opportunities and Basic Skills Training (JOBS), and
transitional child care and medical benefits programs. For example, data are
lacking to determine the outcomes of the transitional benefit programs that
are focused on helping families move from welfare dependency to
self-sufficiency. Unless HHS renews its data collection and evaluation
efforts, the Congress will have insufficient information with which to judge
the effectiveness of these programs.

HHS's Administration for Children and Families (ACF) also needs to work more
closely with states to develop automated data systems. These systems could
help states provide high-quality services to welfare clients, better manage
increasing caseloads, and provide information needed to assess policies.
However, ACF's inadequate oversight of and assistance to states have resulted
in wasted federal and state moneys. For example, ACF allowed several states to
develop severely flawed child support enforcement systems at a cost of
millions of dollars in federal funds before these efforts were redirected.
Federal funding for development of state systems expires in 1995, and it is
unlikely that all states will have developed effective systems by then. In
addition, ACF has not been effectively monitoring states' efforts to develop
automated eligibility systems for AFDC and Medicaid programs, allowing
millions of dollars to be spent on systems that either do not work or do not
meet functional requirements.

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Developing Goal-Oriented Program Performance Standards

Process-oriented measures, such as how many people participated or the
percentage of cases completed within a given time, are used to assess states'
performance and reward them in the JOBS and child support enforcement
programs. These measures, however, do not always bring about desired program
outcomes like obtaining support for children or helping families achieve
self-sufficiency. States need outcome-oriented performance standards to
achieve program goals and improve their operations.

The Family Support Act mandates that, by October 1993, the Secretary of HHS
submit recommendations for JOBS performance standards to the Congress. Also,
although not legislatively required to do so, HHS is beginning to work with
states to develop similar performance standards for the child support
enforcement program. To date, however, progress has been slow. ACF needs to
move expeditiously to develop outcome-oriented performance standards if it is
to meet the October 1993 deadline.

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IDENTIFYING AND SHARING EFFECTIVE INITIATIVES

In keeping with the flexibility afforded them, states have been experimenting
with different approaches to operating their AFDC, child support enforcement,
and JOBS programs. Welfare reform initiatives have proliferated as most states
confront economic difficulties. States need a way to share and capitalize on
each other's experiences. To further the federal and state partnership
inherent in most federally funded human services programs, HHS should play a
much more active role in identifying the more effective practices,
disseminating information about them, and helping states implement them.

_______________________________________________________________________________

EXPANDING STATES' USE OF CHILD WELFARE FUNDS
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Among its responsibilities for child welfare services, HHS provides states
with funding to ensure the welfare of children that a state determines are
at-risk of being removed from their homes. In recent years, reported cases of
child abuse and neglect and foster care caseloads and expenditures have grown
against a backdrop of state fiscal crises. This foster care growth is expected
to continue because of the increased number of very young, drug-exposed
children who may stay longer and need more expensive treatment. Some states
have tried prevention and early intervention services, such as intensive
in-home skill training in parenting and crisis management for at-risk
families. These services show promise and could slow caseload growth, but
states are finding it increasingly difficult to finance them.

Current legislation provides limited funding for prevention and early
intervention efforts. Titles IV-B and XX of the Social Security Act provide
modest funding that states can use for these activities; foster care funds
available under Title IV-E of the act cannot be used in this way. Providing
states with greater flexibility to use Title IV-E funds for prevention and
early intervention efforts could encourage them to select the most appropriate
child welfare services. ACF and states should place greater emphasis on
prevention and early intervention activities in an attempt to keep families
intact and hold down future federal and state child welfare costs.

HHS should also move aggressively to issue regulations establishing a national
foster care information system to provide outcome-oriented data on child
welfare services in general and on foster care in particular, so that informed
decisions can be made about the most appropriate care for individual children.
Such a system was legislatively mandated in 1986 and was to be completed by
October 1991. However, as a result of HHS's delays in issuing final
regulations, little progress has been made in developing the system.

Other actions that HHS could take to help reduce the growing number of
children in foster care and keep families intact include

-- establishing outcome-oriented performance standards for the child welfare
  program to help identify what does and does not work and encourage states
  to adopt more effective practices, and

-- serving as a clearinghouse on better practices for states to use in
  operating their programs, including disseminating information on effective
  caseworker and foster parent recruitment, training, and retention and on
  adoption outreach.

_______________________________________________________________________________

ALLOCATING FDA'S RESOURCES EFFICIENTLY AND ESTABLISHING A REGULATION TRACKING
SYSTEM
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The Food and Drug Administration undertakes a wide range of
responsibilities--such as protecting the nation against impure and unsafe
foods, drugs, cosmetics, and medical devices--with a modest amount of
resources. From 1980 through 1989, FDA's staff decreased by 587, or almost 8
percent, while the Congress enacted 13 new laws expanding the agency's
responsibilities. FDA estimates that it will need a budget of $1.4 billion in
1994 to meet its responsibilities--a substantial increase over its $800
million 1993 budget. While recent legislation permitting FDA to collect user
fees to support review of new drug applications should provide some relief, no
additional funding is available to meet other responsibilities, such as
medical device regulation despite a growing backlog of applications for
approval of new devices.

As part of its increased responsibilities, FDA was required to issue numerous
new regulations to implement legislation. We found, however, long delays and a
lack of overall direction in the agency's process for developing regulations.
FDA agreed in principle with our recommendation that it create an agencywide
system for tracking regulation development, but it has not yet done so. FDA
needs to establish this system to efficiently manage its regulatory process.

In the past, FDA has had trouble assessing its needs and assigning priorities
to its activities. Recently, however, the agency completed a detailed needs
assessment, looking 5 years into the future, that could enable it to allocate
its resources efficiently. This assessment describes the resources FDA needs
to reach specific goals by 1997. To help FDA fulfill its many responsibilities
with existing staff, the Congress should ensure that FDA uses the goals of
this needs assessment as the basis for setting priorities agencywide and
allocating the resources the Congress provides.

Structural flaws in the federal government's food safety system have been
widely reported. Such flaws can affect the public's health and erode
consumers' confidence in the federal government's ability to ensure food
safety and quality. Many of these flaws can be attributed to the fragmentation
of responsibility for food safety and quality among several federal agencies.
The recent controversy between the Department of Agriculture and FDA over
nutrition labeling for food products illustrates the jurisdictional problems
associated with this fragmentation. The need for a uniform, risk-based
inspection system to ensure a safe food supply is discussed in another report
in this transition series, _Food and Agriculture Issues_ (GAO/OCG-93-15TR,
Dec. 1992).

_______________________________________________________________________________

RELATED GAO PRODUCTS
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DEPARTMENTAL ISSUES

_Management of HHS: Using the Office of the Secretary to Enhance Departmental
Effectiveness_ (GAO/HRD-90-54, Feb. 9, 1990).

_Health and Human Services Issues_ (GAO/OCG-89-10TR, Nov. 1988).

===============================================================================
HEALTH CARE FINANCING

_Medicare Claims_ (GAO/HR-93-6, Dec. 1992).

===============================================================================
SOCIAL SECURITY

_Social Security Disability: Growing Funding and Administrative Problems_
(GAO/T-HRD-92-28, Apr. 27, 1992).

_ADP Planning: SSA's February 1989 Report on Computer Modernization Is
Incomplete_ (GAO/IMTEC-89-76, Sept. 25, 1989).

_Social Security: Status and Evaluation of Agency Management Improvement
Initiatives_ (GAO/HRD-89-42, July 24, 1989).

_GAO's Views on an Independent Social Security Administration and the Personal
Earnings and Benefit Statement_ (GAO/T-HRD-89-23, June 2, 1989).

_Social Security: The Trust Fund Reserve Accumulation, the Economy, and the
Federal Budget_ (GAO/HRD-89-44, Jan. 19, 1989).

===============================================================================
WELFARE REFORM

_Welfare to Work: States Serve Least Job-Ready While Meeting JOBS
Participation Rates_ (GAO/HRD-93-2, Nov. 12, 1992).

_Welfare to Work: Implementation and Evaluation of Transitional Benefits Need
HHS Action_ (GAO/HRD-92-118, Sept. 29, 1992).

_Child Support Enforcement: Timely Action Needed to Correct System Development
Problems_ (GAO/IMTEC-92-46, Aug. 13, 1992).

_Welfare Programs: Ineffective Federal Oversight Permits Costly Automated
System Problems_ (GAO/IMTEC-92-29, May 27, 1992).

_Welfare to Work: Effectiveness of Tribal JOBS Program Unknown_
(GAO/HRD-92-67BR, Mar. 19, 1992).

_Interstate Child Support: Wage Withholding Not Fulfilling Expectations_
(GAO/HRD-92-65BR, Feb. 25, 1992).

_Interstate Child Support Enforcement: Computer Network Contract Not Ready to
Be Awarded_ (GAO/IMTEC-92-8, Oct. 23, 1991).

_Welfare to Work: States Begin JOBS, but Fiscal and Other Problems May Impede
Their Progress_ (GAO/HRD-91-106, Sept. 27, 1991).

===============================================================================
CHILD WELFARE SERVICES

_Child Abuse: Prevention Programs Need Greater Emphasis_ (GAO/HRD-92-99, Aug.
3, 1992).

_Foster Care: Children's Experiences Linked to Various Factors; Better Data
Needed_ (GAO/HRD-91-64, Sept. 11, 1991).

===============================================================================
FOOD AND DRUG ADMINISTRATION

_Food Safety and Quality: Uniform, Risk-Based Inspection System Needed to
Ensure Safe Food Supply_ (GAO/RCED-92-152, June 26, 1992).

_FDA Regulations: Sustained Management Attention Needed to Improve Timely
Issuance_ (GAO/HRD-92-35, Feb. 21, 1992).

_Food Safety and Quality: FDA Needs Stronger Controls Over the Approval
Process for New Animal Drugs_ (RCED-92-63, Jan. 17, 1992).

_FDA Resources: Comprehensive Assessment of Staffing, Facilities, and
Equipment Needed_ (GAO/HRD-89-142, Sept. 15, 1989).

_______________________________________________________________________________

TRANSITION SERIES
-------------------------------------------------------------------------------

===============================================================================
ECONOMICS

_Budget Issues_ (GAO/OCG-93-1TR).

_Investment_ (GAO/OCG-93-2TR).

===============================================================================
MANAGEMENT

_Government Management Issues_ (GAO/OCG-93-3TR).

_Financial Management Issues_ (GAO/OCG-93-4TR).

_Information Management and Technology Issues_ (GAO/OCG-93-5TR).

_Program Evaluation Issues_ (GAO/OCG-93-6TR).

_The Public Service_ (GAO/OCG-93-7TR).

===============================================================================
PROGRAM AREAS

_Health Care Reform_ (GAO/OCG-93-8TR).

_National Security Issues_ (GAO/OCG-93-9TR).

_Financial Services Industry Issues_ (GAO/OCG-93-10TR).

_International Trade Issues_ (GAO/OCG-93-11TR).

_Commerce Issues_ (GAO/OCG-93-12TR).

_Energy Issues_ (GAO/OCG-93-13TR).

_Transportation Issues_ (GAO/OCG-93-14TR).

_Food and Agriculture Issues_ (GAO/OCG-93-15TR).

_Environmental Protection Issues_ (GAO/OCG-93-16TR).

_Natural Resources Management Issues_ (GAO/OCG-93-17TR).

_Education Issues_ (GAO/OCG-93-18TR).

_Labor Issues_ (GAO/OCG-93-19TR).

_Health and Human Services Issues_ (GAO/OCG-93-20TR).

_Veterans Affairs Issues_ (GAO/OCG-93-21TR).

_Housing and Community Development Issues_ (GAO/OCG-93-22TR).

_Justice Issues_ (GAO/OCG-93-23TR).

_Internal Revenue Service Issues_ (GAO/OCG-93-24TR).

_Foreign Economic Assistance Issues_ (GAO/OCG-93-25TR).

_Foreign Affairs Issues_ (GAO/OCG-93-26TR).

_NASA Issues_ (GAO/OCG-93-27TR).

_General Services Issues_ (GAO/OCG-93-28TR).